A prospective cohort study was performed to collect baseline data concerning surgical site infections (SSIs) and antimicrobial prophylaxis (AMP) in a remote sub-Saharan district hospital. The SSI rate of 22% was high. Most (88%) of the patients received prophylaxis after incision, and only 5% within the 30-min period before incision. Of all pathogens isolated from SSIs, 60% were resistant to the agent administered. The antibiotics given most frequently were chloramphenicol (60%), aminopenicillins (23%) and benzylpenicillin (15%). Staphylococcus aureus (36%), Escherichia coli (5%) and enterococci (4%) were the pathogens isolated most commonly from SSIs.